A number of newer treatments are currently being developed and assessed for localised prostate cancer. While some are available in Australia, most do not attract Medicare or private health insurance benefits and can be costly.
Cryosurgery or freezing of the tumour tissue with liquid nitrogen is available to treat low to intermediate risk cancer that has not spread outside the prostate. Ultrasound during the procedure is used to guide the extent of freezing. It is not suitable for large prostates. Side effects include impotence and urinary incontinence. We don’t have long term data on cancer control and for this reason it is not recommended as a primary therapy (1). It may be offered as ‘salvage’ therapy after radiotherapy that has failed to control the cancer.
High intensity focused ultrasound (HIFU) is heating of tissue using microwaves. It is being used for localised and more advanced prostate cancer, but is not widely used in Australia. Side effects may include urinary retention (blockage of urine flow) and a prolonged period wearing a catheter. Long term outcomes are hard to measure.
Focal therapy is the removal or ‘ablation’ of small areas of cancer within the prostate gland. Its success depends on cancers being low risk, very small (less than one-tenth of the prostate) and knowing the exact position of the cancer. Because the rest of the prostate is left intact, it is thought that this type of therapy may involve less disruption to the nerves and tissues involved in erections and so have fewer side effects. The disadvantages are that re-treatment may be necessary and it may miss some cancers. The approach is considered experimental.
1. National Comprehensive Cancer Network. Prostate cancer –
v2.2010. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. NCCN, 2010 [accessed 3.3.2011]..